The Child Survival Strategy

Its specific objectives are:
• To proportionally reduce the neonatal, infant and child mortality rates while achieving
the overall objective
• To ensure the greatest possible reduction of mortality among the children of the poorest
and most marginalized sections of the population.
• To contribute to the reduction of maternal mortality to achieve the Millennium
Development Goal by 2015
• To ensure the availability of quality essential health care for women and children in the
community and health facilities

The strategy focuses on:

• the health system, but long term gains will also depend on progress in other sectors, 
• reducing poverty
•  improving food security, 
• raising levels of maternal education and the status of women in society, 
• and the provision of safe water and sanitation.

The main pillar of the strategy is the Health Service Extension Program, which aims to scale
up coverage of essential health services to the rural community. Success will depend on this
program being rolled out as rapidly as possible while ensuring high quality care and full
coordination of its activities and integration with higher tiers of the health service.

Implementation of the Key Interventions
The Strategy spells out the actions to be taken at each level of the health system, starting with
the community. The emphasis is on prevention and promotion, but first level treatments of
malaria and diarrhoea have been added to the original Health Service Extension Program.
Basic treatment of common killers was added to save lives in the interim before promotive
actions are fully effective and to enhance the credibility, and thus, the effectiveness, of the
HEWs’ efforts in prevention and promotion.

The focus on key interventions has implications for the planning and development of the
various programmes and delivery mechanisms within the health system. This presents an
opportunity to focus on essential programme improvements in a way that will produce rapid,
observable results.

Three levels of the health system are involved. Most of the key interventions start in the
community and Health Post. Much of the preventive and promotive work is the primary
responsibility of the HEWs, as the management of illness starts with the family’s ability to
recognise the illness and seek early treatment. All of these actions must be supported by the
Health Centre staff, through the provision of referral care, technical support and close
collaboration with the HEWs. The District Hospitals have an important role in referral care,
training and in operational research.

The Strategy, therefore, requires action to build and maintain the capacity at all three levels.
The Woreda Health Office must be strengthened to effectively plan, support and monitor the
necessary actions and inputs at all three levels. The focus needs to be on overcoming the
major bottlenecks of access to care, increasing availability of skilled human resources,
improving supply and logistics, systems strengthening for the effective supervision and the
referral of women and children who need higher level care.